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Kidney Stones

Dr. Tony Chen answers some of the common questions about kidney stones.

How do kidney stones form?

Some patients eliminate an excess amount of certain substances, or do not take in enough fluid, in which case crystals precipitate out and start forming stones. Common stone types are calcium oxalate, uric acid, struvite (often due to recurrent urinary tract infection) and cystine.

What are the symptoms of kidney stones?

Some stones cause no symptoms. However, sometimes stones can start moving down the ureter and cause blockage. Patients may then develop pain in the flank, lower back, lower abdomen or groin area. There may also be blood in the urine, urinary frequency and urgency. In severe cases, patients may have fever, nausea, and severe pain.

Who is at risk for forming kidney stones?

Risk levels increase with certain habits, such as limited fluid intake or excess animal protein, salt or oxalate ingestion. Oxalate is high in foods such as rhubard, spinach, leafy tea, chocolate, strawberries and pecans. Kidney stones can be more prevalent in people living in certain geographic areas (such as in Southern states).

How do you treat kidney stones without surgery?

Control symptoms: This may include non-steroidal anti-inflammatory (NSAIDs) drugs such as ibuprofen (Advil®, Motrin®) or naproxen (Aleve®), or, more commonly, narcotics. It is important to verify with your doctor whether it is safe for you to take NSAIDs, as this could impact your kidney function or delay certain surgeries (due to blood thinning effect of NSAIDs; same with Aspirin).

Promote passage of the stone: Certain medications such as Tamsulosin (Flomax®) can help with passage of small stones that are close to the bladder. In patients with uric acid stones, these can be slowly dissolved with increased hydration and alkalinizing the urine. However, most other types of stones cannot be dissolved. If you are trying to pass a stone and develop fever, you will need to seek medical attention immediately. If an infection develops in a kidney that is blocked by a stone, this becomes a medical emergency.

What are some surgical treatments for kidney stones?

The common surgical treatments include extracorporeal shockwave lithotripsy (ESWL), ureteroscopy (URS) with laser lithotripsy and percutaneous nephrolithotomy (PCNL). ESWL involves breaking up stones with ultrasonic energy sent in from outside the body. URS requires using a small scope through the urinary tract to break up the stone. PCNL requires a direct access to the kidney through the skin of the back, and is usually reserved for very large stone or patients with complicated anatomy.

Which surgery is right for me?

The choice of surgery depends on stone location, size, composition, and the patient’s medical history and anatomy. The decision about how to treat stones is individualized. The Everett Clinic urologists have expertise in all modern methods of stone treatment and surgery.